Individual
STEPHEN WAYNE YANCOVICH JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
4228 HOUMA BLVD, SUITE 510, METAIRIE, LA 70006-3000
(504) 454-0141
(504) 885-2465
Mailing address
1514 JEFFERSON HWY, SUITE 510, NEW ORLEANS, LA 70121-2429
(504) 842-4000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PENDING
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5CW06PE87
MEDICARE PTAN
LA
Enumeration date
06/15/2011
Last updated
06/17/2016
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